Individual provider Active NPI

Courtney M Otto, LCSW

  • Clinical Social Worker
  • Tucson, AZ
National Provider Identifier
1568757375
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-13750 Issued in AZ
Practice address
504 W 29TH St
Tucson, AZ 85713-3353
Phone
(520) 838-5600
Fax
(520) 792-0654
NPI assigned
Jun 9, 2011
Last updated
Dec 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LMSW-12840 AZ
Clinical Social Worker 1041C0700X LCSW-13750 AZ Primary

Addresses

Primary practice location

504 W 29TH St
Tucson, AZ 85713-3353

Mailing address

504 W 29TH St
Tucson, AZ 85713-3353
Phone (520) 838-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220830002348 TX Practitioner - Clinical Social Worker 6002290723 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LMSW-12840AZMDMental Health Counselor
LCSW-13750AZMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pascua Yaqui Tribe Current Accepting new patients
Pascua Yaqui Tribe CurrentSince May 18, 2022 Accepting new patients
Pascua Yaqui Tribe CurrentSince May 18, 2022 Accepting new patients

Locations

7490 S Camino de Oeste
Tucson, AZ 85746
Phone (520) 879-6039

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1568757375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 W 29TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857133353",
            "telephone_number": "520-838-5600",
            "fax_number": "520-792-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W 29TH ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857133353",
            "telephone_number": "520-838-5600",
            "fax_number": "520-792-0654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "COURTNEY",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-09",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LMSW-12840",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-13750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.